Radiation therapists should report exposures: Exp

The first radiation death in Delhi`s Mayapuri area was a wake up call not only in the area of handling and disposing of such hazardous material but
also in the misadministration of radiation treatment.

Mumbai: The first radiation death in India
in Delhi`s Mayapuri area was a wake up call not only in the
area of handling and disposing of such hazardous material but
also in the misadministration of radiation treatment
(radiotherapy) in some hospitals in the country, experts said.

This kind of misadministration could lead to either
overdose or underdose to patients and hamper the treatment
process, sometimes leading to their death, experts from Bhabha
Atomic Research Centre (BARC) and Atomic Energy Regulatory
Board (AERB) said here.

"The first radiation death in India due to the
unfortunate radiation incident in Delhi should serve as a
wakeup call for other equally important areas of concern.
Botched up radiation treatment may be the next," Dr K S
Parthasarathy, a Raja Ramanna Fellow of Department of Atomic
Energy and former secretary, AERB, said.

"Though the licensees carrying out radiation therapy
using accelerators and Cobalt-60 units and remote after
loading equipment are required to investigate and submit
written reports on accidental exposures, AERB has not received
any so far," Parthasarathy said in an interview.

"I believe that misadministrations are occurring in
radiation treatment. No one reports them. Rule 26 in the
Atomic Energy (Radiation Protection) Rules, 2004 addresses the
issues," said Parthasarathy, who is helping currently AERB
with these issues on request.

In radiotherapy, radiation can turn out to be a double
edged sword. Recent developments in advanced countries such as
USA indicate that there must be vigorous attempts towards
safer radiation treatment, BARC scientists said.

The botched up radiotherapy in several hospitals in USA
and Canada during 1974 to 1992 affected 466 patients; four of
them died. In one instance, a radiation source of high
activity remained inside a patient for four days as it got
accidentally detached. The patient got exposed to over 889
times the prescribed dose. Ninety four other individuals got
exposed inadvertently.

There is phenomenal increase in the number of medical
accelerators, Cobalt-60 units and remotely operated after
loading equipment in India. The AERB, the agency enforcing
radiation safety in India, issues licences to hospitals only
if they satisfy prescribed conditions including availability
of qualified personnel, Parthasarathy said.

The Board has published relevant safety codes on the
subject. The hospitals owning and operating radiation
equipment shall satisfy the provisions in the codes.

"Though the licensees carrying out radiation therapy
using accelerators and Cobalt-60 units and remote after
loading equipment are required to investigate and submit
written reports on accidental exposures, AERB has not received
any so far," Parthasarthy said.

BARC had started a postal dose quality audit programme
in 1976, with nine hospitals using cobalt-60 machines. Now the
scientists in the Radiation Standards Section, BARC, send
capsules containing specially prepared thermo-luminescent
powder to the participating hospitals. As per instruction, the
medical physicist in the hospital exposes them to a specific
dose under specified conditions before returning them to BARC.

"BARC scientists estimate the dose accurately," he said.
Most hospitals deliver accurate doses to patients. AERB and
BARC have asked hospitals showing unacceptable errors to
stop treatment of patients till the issues are resolved. The
service covered over 250 hospitals in India.

"Occasionally, BARC scientists have noticed serious
errors like during 2007-2008 eight beams showed serious errors
ranging from -13.2 per cent to 72.8 per cent, due to
calculation errors or mistaken irradiation of capsules. A
positive deviation leads to under-dosing and inadequate
treatment," Parthasarthy said.

It is appalling to note that several hospitals do not
participate in this virtually free service which provides an
independent verification of radiation dose. During February
2006, BARC invited 100 hospitals to the audit programme but
only 33 turned up, he said.

"Cancer patients or their relatives may ask the hospital
whether they have joined the dose audit programme of BARC.
This may force the hospitals to join the scheme. During
inspections, AERB officials must ask the hospitals to show the
records of BARC dose audit programmes," Parthasarathy and
scientists from health physics division of BARC said.

Replying to a query as to how and why India should be
concerned and take preventive steps towards a safer radiation
treatment, Parthasarathy said, "This year, The New York Times
(January 24, 26, 27 issues) described several instances of
bungled radiotherapy in USA and lessons should be learnt from
that."

Radiotherapy is a popularly used mode for cancer
treatment. About 60 per cent of cancer patients may require
some form of radiation treatment. The recent humongous errors
in radiotherapy in USA led to gruesome consequences, he said.

Dose audit programme covering all hospitals must be
made mandatory, the expert said.